Epidural? No, thank you.

August 20, 2010

Photo Credit: iStockPhoto

I was lucky. No one really questioned my resolve to have a natural unmedicated birth when I was pregnant with my first child (or my second). I’m sure most people were thinking I was crazy. They just didn’t say it. No comments for me like, “You don’t have to be a hero” or “There’s no medal.” I’m very thankful because most women, if they share their plans for a natural birth, especially a first-time mom, will hear something of that sort.

The epidural rate in the United States is high. The majority of us do whatever we can to avoid pain. People misunderstand a woman’s reasons for not wanting pain medication during birth. It really shouldn’t be a surprise that people would react with such thoughts and words.

But it’s very disheartening to a pregnant woman when they do.

I’m hoping that thru this blog I can help people understand why a woman would want a natural birth. Let’s start with Epidurals, since they are so popular!

One of the reasons I wanted a natural birth is because there are side effects and risks with Epidural Analgesia. You don’t hear about them much (if at all) but they do exist. I decided that unless an epidural was medically necessary, I was not going to have one. Just wasn’t worth the risk for me.

The following are from Your Pregnancy & Birth (4th Ed), a book written in conjunction with ACOG (the association that looks out for the best interests of OB/GYNs). Italicsare my comments.

An epidural can cause your blood pressure to decrease. This, in turn, may slow your baby’s heartbeat. Which may lead to the need to deliver your baby quickly, either by forceps, vacuum extraction or cesarean. No thanks. According to studies, a decrease in blood pressure occurs in 30-35% of patients who receive an epidural (not all of these women will end up with assisted deliveries as there are ways to treat the drop, often with more medicine).

After delivery, your back may be sore from the injection for a few days. However, an epidural should not cause long-term back pain. It’s really fun to be dealing with back pain while taking care of a newborn round the clock and learning how to breastfeed. The good news in all this is that it SHOULD not cause long-term back pain. The bad news is that it could. There are plenty of stories told by women who have experienced long-term back pain after an epidural.

If the covering of the spinal cord is pierced, you can get a bad headache. If it’s not treated, this headache may last for days. This is rare. It happens to less than 1% of women who receive epidurals. Still, I wouldn’t want to be one of them. “A bad headache” doesn’t even start to describe the pain. My husband had a spinal headache after a spinal tap several years ago. I have never witnessed anyone in greater pain. He couldn’t even stand up straight. I had to help him to the bathroom. He couldn’t feed himself. I can’t even imagine the disaster that would be with a newborn baby. If you want to read more about an epidural headache, click HERE.

When an epidural is given late in labor or a lot of anesthetic is used, it may be hard to bear down and push your baby through the birth canal. This can also lead to a vacuum extraction, forceps or cesarean delivery. Again, no thanks.

How many women have read the pamphlet that comes with the medication used in the epidural (manufactured by Abbott Labs)?

Local anesthetics rapidly cross the placenta, and when used for epidural, caudal or pudendal anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity….

Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid.

There are many other risks associated with Epidural Analgesia that aren’t even touched on in the ACOG book. Some of them are mentioned in the drug pamphlet quoted above. For more information please check out these sites: Birth Resource Network and PainFreeBirthing.com.

It fascinates me that we rush to use medicine to avoid risks to ourselves and babies yet we JUMP at the chance to have an epidural, which carries risk! I suspect that most women either don’t know the risks or are so scared to death of the pain of childbirth that they just don’t care.

I chose a natural birth for other reasons as well. We’ll talk about those in the next few days. Not having an epidural was a starting point for me. It was never really about just not having an epidural. It was about choosing a totally different birth experience.

If you had an epidural, did you experience any of the side effects listed above? Were you aware of all the risks and side effects BEFORE you chose to have an epidural?

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I had an epidural and the only side effect I had was not being able to feel enough to push when Isabelle was ready to come out. They turned down my dosage and threatened to get the vacuum and I kept pushing as hard as I could. Thankfully she came out on her own!

My doctor is the head of Family Beginnings (a place in the hospital where you give birth in a real bed in a bedroom-type room with no IV for natural births) and I asked him about epidurals and he said it wouldn’t affect the baby at all–that it only remained in my spinal cord and the only effects would be on me, not the baby. I figured he would be against epidurals since he is in charge of FB, so I was surprised at his answer. Except natural childbirth supporters disagree with what he told me. There is so much conflicting information out there.

Thanks for replying Bethany! If you choose an epidural again, you can ask that the epidural medicine be turned down and then wait to push until you feel a little more. That’s what I did with Emmett. Once I could feel a bit more it was much easier – and I still didn’t feel pain – just pressure.

I would ask your doctor for proof that it doesn’t affect the baby. I cannot find any conclusive research studies that show it has no affect on the baby. It has been documented that ‘epidural babies’ tend to have a more difficult time with breastfeeding at the beginning (trouble latching on). Not 100% of them but enough that it is cause for concern. Also, I have read that MANY Labor & Delivery nurses can easily tell the difference between the baby of a mother who didn’t receive an epidural and one whose mother did receive an epidural, without ever knowing who had the drugs or not. I think that’s telling.

I had epidurals with both of my children. With the first, I did have a backache lasting a week or two, but it wasn’t anything major…just a bit of an annoyance. No other side affects. I was dilated to 9 with my son when I received the epidural. I had no difficulty pushing out either baby (7 lb. 1 oz. and about 30 min. of pushing, 8 lb. 11 oz. and about 10 min. of pushing). I was aware of many of the risks (spinal headaches, etc.) though not the ones detailed in the pamphlet. I guess the only complication I had was with my first it didn’t “take” so they had to re-do it, probably causing the backache. If anything, I think the epidural helped my labors keep going as I was able to relax a bit more.

No epidurals here with either child. I by no means claim to be a “hero” of any sort, I had just decided from day 1 of my pregnancy that I would have an unmediated childbirth to give my baby what I felt was the best possible beginning. Plus after all the comments of ” You’ll never make it” my strong will came into play and there was NO WAY I was doing anything but unmedicated!
For me the only time that I begin to feel like I would need some pain medicine is during transition and that only lasts a little while then it is time to push and I was good to go!

I had an epidural with my first and it was a great experience. I got it at about 6cm, and a few hours later I was ready to push. I could push just fine – she was out within about 20 minutes. The only problem was my 6cm internal tear that happened when she was coming out. I had no side effects with the epidural. I went natural with my second, and I’ve gotta say it was excruciatingly painful at the end. Not sure I can go through that again – I’m considering an epidural if God gives us #3!

You know, Christy, I’m a little confused about all these issues. As I said, I had a great epidural experience the first time. Then I read Ina May and all that and “drank the kool-aid” for the unmedicated birth, and my natural delivery was not what I felt I had been promised that it would be. I’m not overstating it to say that it was horrifying during certain moments. There was a point when I literally thought I was going to die. I just don’t know if my physical and mental pain and suffering was worth the “natural” experience. What are your thoughts?

Oh, and I didn’t notice any difference in my 2 babies after delivery, between the “medicated” and the “unmedicated” – both nursed fine after birth and neither was sleepier than the other. The big difference was with me – my legs were shaking uncontrolably and I had the chills (I think they put 7 warmed blankets on me!) after my natural delivery. It took me at least an hour to recover and feel in my right mind. After the epidural birth, though, I felt good (EXCEPT for the horrible stitching up after my tear!) and I happily ate my dinner.

It’s not uncommon to shake after birth – it’s caused by your hormones rapidly dropping back to somewhat normal levels. It can happen with an epidural or without. It doesn’t happen to all women and it may happen for one birth and not another.

If I remember correctly you had a ‘precipitous’ birth with #2, correct? That can definitely be traumatic. Did you have time for an epidural with #2? I linked to an article on the La Leche League website a couple days ago that talked about traumatic births. I think yours certainly falls into their definition of traumatic. Am I right?

The article states: “When considering women’s reactions to their births, I have found it more useful to consider the subjective characteristics. Psychologist Charles Figley describes some subjective aspects in his classic book Trauma and Its Wake. In looking at the whole range of traumatic events, he suggests that an experience will be troubling to the extent that it seems sudden, overwhelming, or dangerous to the person having the experience. Let’s examine these characteristics in relation to birth.

Sudden: Did things happen quickly? Did things change from “fine” to dangerous in a short time? Did anyone explain what was happening to you?
Overwhelming: Did you feel swept away by the hospital routine? Were you physically restrained? Did you feel disconnected from what was happening? Did you have a general anesthetic?
Dangerous: Was your delivery a medical emergency? Did you develop a life-threatening complication? Was your baby in danger? Did you believe you or your baby might die?”

Even if you didn’t feel any of these things, there are other aspects that may have made the aspect more traumatic for you and not the experience you thought you’d have. For instance, my last was a natural birth in the hospital. I loved giving birth without drugs BUT I hated the ride to the hospital while I was in hard labor and then having to be hooked up to monitors and have people poking at me while I was going thru transition and then being told not to push because the doctor wasn’t there yet. I don’t want that part of it for any of my future births so I’ll probably have the rest of my children at home.

I’m the opposite. I vowed that I would have some sort of drugs (however and epidural was my very LAST resort, I didn’t want a needle to go into my back) and I ended up with a natural childbirth. I progressed so fast that there wasn’t time. Now. I had horrible pain, I was delusional, my contractions were right on top of one another, I couldn’t sit, stand, or even cry. But even after all that if I was to have another child (hopefully I will) I will not use pain meds.
I was ready to go home right after I had my son. We were both feeling great, he took to the bottle wonderfully and I was able to walk around with minimal pain.

Good point Trish and one I didn’t mention above but am planning to discuss further in the next few days. That’s a GREAT reason to prepare yourself for a natural birth even if you think you will want an epidural. The women I’ve known who wanted an epidural and didn’t get one (either because they didn’t take, they were too far along in their labor or the anesthesiologist just couldn’t get to them quick enough) have had pretty traumatic experiences.

I had an Epi with #4 and #5, (out of 6) I thought that #4 was going to be my last and I had never experienced an Epidural with the first 3, so I thought why not try it…. They tried to place it 4 times, through 45 minutes of very uncomfortable surges, then when the next person came in to try, it worked… but then about 10 minutes later I said to the nurse, he’s coming…. she said Ridiculous…. you were only 5cm before your Epi…. I said I think you need to check hes really coming… sure enough my baby was slipping from my body… all by himself the Doc was called she was getting on one glove then holding his head while getting on the robe and the other glove one really small push and he was here, and I still couldnt feel a thing for the next 3 hours!!…. The next one went better.. but after the first I was expecting to feel nothing at all….. after only 1 1/2 hrs under the Epi my next son was born (I got the Epi because I was conned into an induction and all the rest told I couldnt get up so I thought why not try it has to be better than last time and be maybe comfortable..)

I did not get an epidural b/c I was concerned about it slowing down labor, and preferred not to have things attached to me (IV, monitors, etc). In the back of my mind, I would have been OK with getting one if labor got extremely long or for some reason I couldn’t take it anymore.
It was presented as fairly risk free in my childbirth class (“doesn’t cross the placenta, doesn’t affect breastfeeding, if it does slow down labor no problem we’ll just use some pitocin to speed it up again and that doesn’t have any risks either…”).